The Office of the Inspector General has released a report that examines whether the Centers for Medicare & Medicaid Services reports all of its adverse actions to the Healthcare Integrity Protection Data Bank, as required, according to an OIG report.
The HIPDB is a national databank containing reports of adverse actions against healthcare practitioners, providers and suppliers. The database was created to help prevent the employment of potentially fraudulent or abusive providers. The types of adverse actions that must be reported to the HIPDB include licensure and certification actions, exclusions from participation in federal and state healthcare programs, criminal convictions and others. CMS, as well as federal and state government agencies and health plans, is required to report adverse actions to the HIPDB, including terminations of providers from participation in Medicare.
The findings in the report include the following:
• CMS took adverse actions against providers but did not report all of the actions to the HIPDB, which is required.
• None of the 148 adverse actions imposed against laboratories in 2007 had been reported.
• None of the 45 nursing homes terminated from participating in Medicare from 2004-2008 were reported to HIPDB until 2009, which is well after the required reporting timeframe.
The OIG report has made a recommendation to CMS to educate staff and contractors about the types of adverse actions that are required to be reported and the required timeframes for reporting them. CMS has agreed to the recommendations and has described planned efforts to better report adverse actions imposed against providers.
Read the OIG's report "CMS Reporting to the Healthcare Integrity and Protection Data Bank" (pdf).
Read other coverage about Medicare and Medicaid fraud.
- New York Surgeon Charged With Bilking $3.5 From healthcare Insurance Companies
- California's El Centro Regional Medical Center to Pay $2.2M to Settle Medicare Fraud Allegations
- DOJ Investigates Allegations Florida Health System Assisted WallCare in Medicaid Fraud
The HIPDB is a national databank containing reports of adverse actions against healthcare practitioners, providers and suppliers. The database was created to help prevent the employment of potentially fraudulent or abusive providers. The types of adverse actions that must be reported to the HIPDB include licensure and certification actions, exclusions from participation in federal and state healthcare programs, criminal convictions and others. CMS, as well as federal and state government agencies and health plans, is required to report adverse actions to the HIPDB, including terminations of providers from participation in Medicare.
The findings in the report include the following:
• CMS took adverse actions against providers but did not report all of the actions to the HIPDB, which is required.
• None of the 148 adverse actions imposed against laboratories in 2007 had been reported.
• None of the 45 nursing homes terminated from participating in Medicare from 2004-2008 were reported to HIPDB until 2009, which is well after the required reporting timeframe.
The OIG report has made a recommendation to CMS to educate staff and contractors about the types of adverse actions that are required to be reported and the required timeframes for reporting them. CMS has agreed to the recommendations and has described planned efforts to better report adverse actions imposed against providers.
Read the OIG's report "CMS Reporting to the Healthcare Integrity and Protection Data Bank" (pdf).
Read other coverage about Medicare and Medicaid fraud.
- New York Surgeon Charged With Bilking $3.5 From healthcare Insurance Companies
- California's El Centro Regional Medical Center to Pay $2.2M to Settle Medicare Fraud Allegations
- DOJ Investigates Allegations Florida Health System Assisted WallCare in Medicaid Fraud